Meta-LARC Advance Care Planning

Full Title

A Cluster-randomized Trial Comparing Team-based Versus Primary Care Clinician-led Advance Care Planning in the Meta-LARC Practice-based Research Networks

Project description

The Serious Illness Care Program (SICP) is an advance care planning program targeting people with reduced life expectancy. It is a validated tool and is designed to help clinicians initiate meaningful conversations about health care at the right time and in the right way so that patients and families can make more informed choices based on their values and preferences. The objective of this project is to determine whether, in primary care settings, it is more effective to target the implementation of the SICP with a clinician-centred approach, where a single clinician is responsible for having a conversation about advance care planning given the nature of the patient-clinician relationship, or whether it would be better to use a team-based approach given the time and resource constraints faced by clinicians. The target population is adults living in the community with serious diseases who have a life expectancy of two years or less, as well as their families. This is a cluster randomized trial. This study will be conducted in 42 primary care settings within seven Practice-Based Research Networks (PBRNs) 5 located in U.S. states and 2 in Canadian provinces: Colorado, Iowa, North Carolina, Oregon, Wisconsin, Quebec and Ontario. The specific objectives are to 1) evaluate the comparative effectiveness of the two approaches on the match between care and patients' goals and time spent at home (primary outcomes) and on patients' anxiety, depression and quality of life (secondary outcomes); and 2) explore the contextual factors influencing the implementation of the two approaches.  Data collections for patients and caregivers will be conducted at study entry, at 6 months and 12 months, while healthcare professionals will be interviewed after receiving training, as well as at 1 and 2 years after training. The data from this study will help determine the most effective approach to advance care planning for primary care settings. Healthcare professionals who are trained in the use of the SICP will be more comfortable having conversations about advance care planning with their patients. Thus, this study has the potential to improve the delivery of care to patients with serious illnesses and reduced life expectancy, by ensuring that the care provided is consistent with the objectives, values and preferences of the patient and family.  


Project Coordinator

LeAnn Michaels, Oregon Rural Practice-Based Research Network
Sabrina Guay-Bélanger, Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL)
Danielle Caron, Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL)

Project Team

Annette Totten, Oregon Health & Science University
France Légaré, MD, Université Laval
Lyle J. Fagnan, Oregon Health & Science University
Donald Nease, University of Colorado 
David Hahn, University of Wisconsin
Rowena Dolor, Duke University
Barcey Levy, University of Iowa
Michelle Greiver, University of Toronto
Jean-Sébastien Paquette, Université Laval
Patrick Archambault, Université Laval
And the Meta-LARC ACP Trial Team

Project funding agency

Patient Centered Outcome Research Institute (PCORI)

Start and end dates of project financing